Chest Tube Simulation Method and Training Device

ABSTRACT

Disclosed herein is a chest tube trainer model. Specifically exemplified is a an anatomical model for simulating at least a portion of a thorax that includes a rib portion removably secured to and supported by a base, the rib portion comprised in whole or in part of a hydrogel; and a securing member for holding the anatomical model onto a human; wherein the rib portion has a convex shape defining a space between the base and the rib portion, the space is adapted for receiving a bladder disposed between the rib portion and the base; and at least a portion of the base is formed from puncture resistant material.

BACKGROUND

Anatomical simulators have been developed for training and assessment ofmedical students, nursing students, medics and practitioners. Thesesimulators have enabled health care professionals of all backgrounds topractice clinical procedures in a safe environment, away from thepatient. The majority of simulators that have been developed thus farfocus mainly on emergency care, anesthesia and laparoscopic surgery. Inaddition, simulators have been developed for examination of bodycavities.

Various procedures performed in the medical field require significanttraining and expertise to avoid potential serious complications that canarise if not performed correctly. Risks are associated with any medicalprocedure, particularly with those which are more invasive. Many medicalprocedures could improve with improved training devices including chesttube insertion also known as tube thoracostomy. Procedures includinginserting a chest tube typically require the placement of a hollow,flexible tube into the chest into the pleural space. The tube acts as adrain to remove fluids that can form in the pleural space as a result oftrauma, pneumonia, post surgery, and the like.

Regardless of the methods, techniques, or particular materials used,healthcare training is an iterative process and must includeopportunities to practice various clinical skills. One of the mostimportant aspects of clinical training is assessment. Assessment allowslearners to gauge their level of understanding or performance ascompared to their colleagues or a pre-determined standard. Appropriatefeedback is critical to mastering hands-on clinical skills.

Medical training is the only defense in decreasing clinical errors.Thus, simulators that enhance the training of practitioners forprocedures involving direct and indirect contact with patients aredesperately needed. Simulators that can reliably and accurately providefeedback to a practitioner as to the quality of their performance arealso desirable.

DEFINITIONS

It is important to an understanding of the present invention to notethat all technical and scientific terms used herein, unless definedherein, are intended to have the same meaning as commonly understood byone of ordinary skill in the art. The techniques employed herein arealso those that are known to one of ordinary skill in the art, unlessstated otherwise. For purposes of more clearly facilitating anunderstanding the invention as disclosed and claimed herein, thefollowing definitions are provided.

The term “hydrogel(s)” as used herein refers to a unique class ofmaterials that contain a large amount of water and generally exhibit ahigh degree of elasticity and lubricity. These materials are ideal forsimulating the physical properties of many living soft tissues.Hydrogels are materials that are wetable and swell in the presence ofmoisture and retain water without dissolving. These materials aregenerally constructed of one or more hydrophilic polymer molecules,although copolymerization with hydrophobic monomers may also lead to theformation of a hydrogel. These materials are generally elastic, andexhibit a three-dimensional network that is either crosslinked directlyby chemical bonds or indirectly through cohesive forces such as ionic orhydrogen bonding.

The tissues and structures that “are comprised of, in part or in whole,a hydrogel,” aside from hydrogel materials, may include, but are notlimited to, hydrophillic polymers, interpenetrating orsemi-interpenetrating polymer networks, fibers, silicone rubber, naturalrubber, other thermosetting elastomers, other thermoplastic elastomers,acrylic polymers, other plastics, ceramics, cements, wood, styrofoam,metals, actual human tissues, actual animal tissues, and any combinationthereof. For model embodiments comprising one or more components, eachcomponent part may be constructed from one or more tissue analogmaterials.

The luminal structures, fat tissue, muscular tissue, skin tissue, bonetissue, and/or costal cartilage tissue, formulated to simulate one ormore physical characteristics of a target living tissue. These physicalcharacteristics include, but are not limited to, uni-axial ormulti-axial tensile strength or modulus, uni-axial or multi-axialcompressive strength or modulus, shear strength or modulus, coefficientof static or dynamic friction; surface tension; elasticity; wettability;water content; electrical resistance and conductivity; dielectricproperties; optical absorption or transmission, thermal conductivity,porosity, moisture vapor transmission rate, chemical absorption oradsorption; or combinations thereof. Each tissue or structure isdesigned so that one or more of its physical characteristics willsufficiently match the corresponding physical characteristic(s) of therelevant tissue (e.g., bone tissue, skin layer, cartilage, musculartissue) on which the tissue or luminal structure is based. Morespecifically, each tissue analog material is preferably formulated sothat the physical characteristic(s) of the tissue analog fall within arange that is no more than 50% lesser or greater than the targetedphysical characteristic(s) of the relevant living tissue on which thetissue analog material is based.

The aforementioned listed physical characteristics are well understood,and may be determined by well-established techniques. Referencesteaching the determination of different physical characteristics (in noway intended to be an exhaustive list) include the following:

(1) Shigley, J. E., and Mischke, C. R. Mechanical Engineering Design,5^(th) Ed., McGraw-Hill, 1989. (2) Harper, C. A., Handbook of Materialsfor Product Design, 3^(rd) Ed., McGraw-Hill, 2001. (3) Askeland, D. R.,The Science and Engineering of Materials, 2^(nd) Ed., PWS-Kent, 1989.(4) LaPorte, R. J., Hydrophilic Polymer Coatings for Medical Devices,Technomic Publishing, 1997 (5) Hayt, W. H., and Kemmerly, J. E.,Engineering Circuit Analysis, 4^(th) Ed., McGraw-Hill, 1986. (6) Park,J. B., and Lakes, R. S., Biomaterials, An Introduction, 2^(nd) Ed.,Plenum Press, 1992. (7) Lindenburg, M. R., Editor, Engineer in TrainingManual, 8^(th) Ed., Professional Publications, 1992.

Other references of note that are incorporated herein are Ottensmeyer etal., “The Effects of Testing Environment on the Viscoelastic Propertiesof Soft Tissues, Proceedings of Medical Simulation,” InternationalSymposium-ISMS 2004, Cambridge, Mass., Jun. 17-18, 2004 and referencescited therein; and Brouwer et al. “Measuring in Vivo Animal Soft TissueProperties for Haptic Modeling in Surgical Simulation”, Proc. MedicineMeets Virtual Reality, Newport Beach, Calif., IOS Press, 2001, andreferences cited therein.

Particular teachings of certain physical characteristics are noted(references numbers related to preceding list):

Tensile strength and modulus, both measured in Pascal (Pa)—Ref 1, pg186.Compressive strength and modulus, both measured in Pascal (Pa)—Ref 2, pg718.Shear strength and modulus, both measured in Pascal (Pa)—ASTM StandardD3165-00, Standard Test Method for Strength Properties of Adhesives inShear by Tension Loading of Single-Lap-Joint Laminated Assemblies.Coefficient of static and dynamic friction, a dimensionless number—Ref7, pg 445.Surface tension, measured in dynes/cm—Ref 6, pg 57.Wettability, measured in terms of contact angle (degrees)—Ref 4, pg 3.Water content, measured in mass percent (%)—Ref 4, pg 41.Electrical resistance and conductance, measure in ohm for resistance andmho for conductance—Ref 5, pg 25.Dielectric properties, measured in various units—ASTM Standard E2039-04Standard Test Method for Determining and Reporting Dynamic DielectricProperties.Optical absorption and transmission, measured in cm⁻¹—Ref 3, pg 739.Thermal conductivity, measured in cal/(cm—s—C)—ASTM Standard D5930-01Standard Test Method for Thermal Conductivity of Plastics by Means of aTransient Line-Source Technique.Porosity, measured in volume percent (%)—Ref 3, pg 490.Moisture vapor transmission rate, measured in g/(mil-in²)—Ref 2, pg 941.

The term “geometrically mimic” as used herein refers to a comparativerelationship of a configuration of an artificial anatomical model,and/or artificial structural component thereof, with a target anatomicalstructure wherein such configuration comprises one or more similargeometric features of the target anatomical structure to be mimicked,such as length, width, diameter, thickness, cross-section, and/or, inmost cases general shape of a particular target anatomical structure.

The term “human or non-human animal tissue” as used herein refers to theone or more tissues that constitute a human or non-human animalanatomical structure. “Anatomic structures” may include tissue types,bone types, organ types, and/or part of organ(s).

As used herein the term “human or non-human animal anatomical structure”refers to one or more tissue structural components that make up a partof anatomy of a human or non-human animal A part of anatomy may include,but is not limited to, whole organs, parts of an organ, or a section ofa body comprising one or more tissue types, organ types, and/or part oforgan(s).

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows an environmental view of a wearable chest tube trainingdevice (the “device”) showing a perspective view of the device, inaccordance with an embodiment.

FIG. 2 shows a perspective view of the device in the open position, witha portion of the straps removed for ease of viewing, in accordance withan embodiment.

FIG. 3 shows a perspective view of the device in the closed position, inaccordance with an embodiment.

FIG. 4 shows a top view of the device in the closed position, inaccordance with an embodiment.

FIG. 5 shows an alternate environmental view of the device, inaccordance with an embodiment.

DETAILED DESCRIPTION

In this disclosure, reference is made to particular features (includingmethod steps) of embodiments. It is to be understood that the disclosureof embodiments in this specification includes all possible combinationsof such particular features. For example, where a particular feature isdisclosed in the context of a particular aspect or embodiment of theinvention, that feature can also be used, to the extent possible, incombination with and/or in the context of other particular aspects andembodiments of the invention, and in the invention generally.

The term “comprises” is used herein to mean that other features,ingredients, steps, etc. are optionally present. When reference is madeherein to a method comprising two or more defined steps, the steps canbe carried in any order or simultaneously (except where the contextexcludes that possibility), and the method can include one or more stepswhich are carried out before any of the defined steps, between two ofthe defined steps, or after all of the defined steps (except where thecontext excludes that possibility).

This invention may be embodied in many different forms and should not beconstrued as limited to the embodiments set forth herein. Rather, theseembodiments are provided so that this disclosure will be thorough andcomplete, and will convey the scope of the invention to those skilled inthe art.

The terms “distal,” “medial,” “inferior,” and “superior,” refer to theposition of various components' positions in relation to the human bodywhen the assembled device is worn by a human as shown in FIGS. 1 and 5.

FIG. 1 is an environmental view showing a high level view of the device.As shown, embodiments of the device involve a wearable anatomical model(the “model”) to simulate a portion of a human thorax. The model 10includes a rib portion 12 removably or fixedly mounted to a base 14. Therib portion has a convex shape defining a cavity between the rib portion12 and the base 12, the cavity adapted to receive a bladder 16 such thatthe bladder 16 is sandwiched between the rib portion 12 and the base 14.The rib portion 12 simulates human or non human animal ribs and theirsurrounding rib tissue (including muscle, fat, cartilage, and skintissue). The bladder 16 may be a hollow pouch, the exterior of whichsimulates a pleura, such as a visceral pleura and/or a parietal pleura.The hollow space inside the bladder 16 simulates a pleural space/cavityand/or a pleural effusion in which fluid or air or both may accumulate(ex. a hemothorax or pneumothorax or pneumohemothorax, respectively);the bladder 16 is adapted for receiving fluid such as simulated blood orother bodily fluid, or even air and/or fluid. The base 14 serves as asupport for the rib portion 12 and the bladder 16 and includesstructures for securing the rib portion 12 to the model. Because themodel may be used for the training of chest tube insertion procedures,the base 14 also serves to protect the wearer of the model.

FIGS. 2-4 illustrate further details of the anatomical model 10. In FIG.2, the rib portion 12 may include a plurality of ribs 26 surrounded by asoft tissue pad 28 (“tissue pad”). The embodiment shown depicts fiveribs 26. The ribs 26 are convex in shape, separated from each other by aspace simulating the intercostal space, four in number. The ribs 26 arecomprised of a tissue analog material simulating at least one physicalcharacteristic of living bone.

The anatomical model disclosed is characterized by a similarity ofgeometry, of individual component physical properties, and ofcomponent-to-component interfacial properties with living tissues.Individual components of the anatomical model are fabricated such thatthey mimic the geometry of a particular target anatomy. The anatomicalmodel is configured to geometrically mimic at least a portion of a humanor non human animal thorax, wherein the anatomical model furthercomprises at least a tissue pad 28 configured to simulate andgeometrically mimic human or non-human animal rib tissue and ribs 26configured to geometrically mimic human or non human animal ribs. Theanatomical model may further comprise the bladder, which is configuredto mimic and simulate at least one predetermined physical characteristicof a human or non-human animal pleura and/or pleural space.

The tissue pad 28 may be comprised of materials having a structuralintegrity simulating predetermined characteristics of various tissuessurrounding a human or nonhuman animal rib (the “rib tissue”). “Ribtissue” shall refer to tissues that surround the ribs of a human ornon-human animal, such as intercostal muscles, costal cartilage, fascia,fat, and and/or an overlying skin layer.

The tissue pad 28 geometrically mimics at least a portion of a human ornon human animal rib tissue and is configured to simulate at least onepredetermined physical characteristic of rib tissue with at least 50% ormore similarity. The bladder 16 geometrically mimics at least a portionof a human or non human animal pleura, pleural space, or both and isconfigured to simulate at least one predetermined physicalcharacteristic of the pleura, pleural space, or both with 50% or moresimilarity in an embodiment. The ribs 26 geometrically mimic at least aportion or a plurality of human or non human animal rib bones and areconfigured to simulate at least one predetermined physicalcharacteristic of human or non human animal living bone.

The tissue pad 28 may be comprised in whole or in part of hydrogel or“hydrogel materials,” as that term is defined and used in United StatesPatent Application Publication No. US20140302474 A1 to the presentinventor, which is incorporated herein by reference in its entirety. Thetissue pad 28 may be a layered tissue pad having an outermost layer ofsimulated skin tissue (a “skin layer”), a layer underneath the skinlayer comprising simulated fat tissue, and a layer or layers of materialsimulating muscular tissue and/or costal cartilage tissue on theinnermost portions of the tissue pad 28. All portions of the tissue pad28 simulate at least one predetermined characteristic of theirrespective tissue type with 50% or more similarity. The hydrogeloccupying the innermost portion of the tissue pad simulates tissuespresent in and around the intercostal space of a human or non-animalhuman animal, such as intercostal muscles, costal cartilage, andmembranes while the hydrogel on the surface of the tissue pad 28 maysimulate skin and fat tissue.

The at least one predetermined characteristic of the aforementioned ribtissue, pleura, pleural space, and living bone comprises at least one ofthe following: color, tensile modulus, shear strength, punctureresistance, compressive modulus, dielectric constant, electricalconductivity, and/or thermal conductivity. The tissue pad 28, bladder16, and ribs 26 exhibit a coefficient of friction and punctureresistance with 50% or more similarity with human or non-human animalrib tissue, pleura, pleural space, and living bone, respectively. Otherpredetermined characteristics may be simulated, for example the hardnessof living bone; these are provided as examples.

In an embodiment, base 14 of FIG. 1 is comprised of a number of smallercomponents, some or all of which are visible in FIGS. 2-4. Base 14 maycomprise a chassis 32 having a clamp 20 on one end and a binding 42 onthe other end, as shown. The chassis may also have a curved shape so asto contour to a typical torso. The base 14 also may include a pad 34engaged with the underside of the chassis 32. Collectively, thesecomponents make up the base 14 of FIG. 1 and will be described in turn.

First, because the device is intended as a chest tube insertion trainingdevice, it is naturally subject to puncture by sharp as well as bluntobjects such as needles, medical clamps, tubes, and/or automated devicesas may be developed for use in chest tube insertions and the like. Forthis reason, the chassis 32 may be constructed in whole or in part fromone or more puncture resistant materials, such as layeredpuncture-resistant fabrics, plastics, or other material(s) capable ofresisting puncture and tearing upon impacts by surgical instruments,needles, mechanical devices, and the like. A puncture resistant materialused in an embodiment resists puncture by instruments having more than 1Newton of applied force, as determined by the ASTM F2878-10 standard forneedle resistance if the puncture resistant material is a layeredfabric. This range would protect the wearer of the model from mostmanually driven instruments which can impact the model during use.

In other embodiments, the chassis may be constructed from armor gradematerial. Armor grade material may be a plastic composite with ahardness of at least 80-95 HRR (for example, the acrylic-polyvinylchloride composite known as Kydex®). The armor grade material may alsobe steel, ceramic, or ballistic grade steel having a hardness of atleast 70-100 HRB.

Other puncture resistant materials and armor grade material known in theart for protecting a human actor or mannequin from injury when thedevice is worn and used may be used. In addition to resisting puncture,material used in whole or in part in the chassis should also beresistant to tearing. Preferably, both puncture resistant materials andarmor grade materials resist tearing upon impacts having a kineticenergy between 200-300 joules. The chassis may also be covered with oneor more layers of plastic or fabric.

The rib portion 12 may be opened and closed like a book, allowing fordisassembly and storage of the individual components. To enable thisfeature, the base 14 includes a binding 42 and clamp 20, each engagedwith the chassis 32. FIG. 2 shows the rib portion 12 in the openposition. FIG. 3 shows the rib portion 12 in the closed position. Thebinding 42 pivotally engages with the distal ends of the ribs, allowingthe rib portion 12 to open and close. The clamp 20 serves to secure therib portion 12 in the closed position.

To secure the rib portion 12 in the closed position, the proximal endsof the ribs 26 engage securely with clamp 20. The clamp 20 may include asub-plate 22 and a retaining plate 24, together secured by means knownin the art, such as screws or pins. In the embodiment shown, thesub-plate 22 and retaining plate 24 are secured together by insertingL-shaped pins (“pins”) 30 through bores located in front and rearlocking structures 44, 46, which are located adjacent to the sub-plate22. Other clamps or clamping means known in the art may be used, such asthe alternate clamp 50 shown in FIG. 5. Preferably, the clamping meansshall be easy to open and close.

The binding 42 may be any pivotally moveable binding. The embodimentshown includes openings for receiving the distal ends of the ribs 26,however other bindings may be employed. When the rib portion 12 is inthe open position, a user may remove the tissue pad 28 from the ribs 26for storage of the tissue pad 28 in a moist environment. It also allowsfor the placement of a bladder 16 between the chassis 32 and the ribportion.

The bladder 16 may be a removable, hollow structure or pouch. Asmentioned previously, the exterior of the bladder may simulate a pleuraand the empty cavity within the bladder may simulate a pleural space.The bladder 16 may have a roughly cuboid shape. The bladder is adaptedto receive and hold contents, such as liquids, fluids, and/or air usingmeans known in the art for filling hollow structures. One example meansfor the bladder 16 to receive liquids is via injection of fluid(s) fromsyringe 40 via a tubular member 31 and stopcock 36 engaged with anopening (not shown) in the bladder 16. Other means for introducingfluid(s) into the bladder are known in the art and contemplated herein.Also, the means for introducing fluid(s) into the bladder may be locatedon other parts of the bladder 16, not just the location shown in theembodiment of FIG. 2. The bladder may be made of standard engineeringmaterials such as silicone rubber, synthetic tissues that partiallyincorporate hydrogels, or hybrid constructs that include both or othermaterials such that the bladder as a whole simulates a pleura or pleuralspace, or both, of a human or nonhuman animal pleura, pleural space, orboth with 50% or more similarity. The device may also include a layerinterfaced between the bladder 16 and rib portion comprising a synthetictissue (ex. a hydrogel) bonded to or in communication with silicone.

FIG. 4 is a top view of the anatomical model 10 and shows how thebladder 16 fits in the space formed between the rib portion 12, which isconvex, and the base's 14 chassis 32. The fit is snug so as to simulatea plural space and surrounding tissues of a human or non human animalwith at least 50% similarity.

As mentioned previously, the device is preferably used for chest tubeinsertion training. One feature of an embodiment of the device includesa securing member 18, such as the straps shown, configured to wrap thebase 14 and rib portion 12 securely around a human 56. “Human” in thiscontext may be a live human patient actor or mannequin. These straps maybe made of a durable flexible material, such as nylon, and may employfastening means such as buckles, snaps, Velcro®, or the like fasteningmeans for securing the securing member onto the human Other materialsknown in the art may be used.

One benefit of the device is that it may be worn by a live patientactor. The presence of a live human underneath the model 10 imparts morerealism to training methods performed using the model 10. In cases wherea patient actor is not available, training may take place on a mannequinor other synthetic model on hand. In embodiments where the human figureis a synthetic model, the synthetic model may be considered a part ofthe device.

In addition to the device itself, a method is disclosed for performingchest tube insertion training employing the above described device.

EXAMPLE

The device may be used to perform a chest tube insertion procedureperformed via an intercostal space as follows: First, the anatomicalmodel 10 is assembled. The clamp 20 is opened and the rib portion 12placed in the open position. The tissue pad is then inserted over theribs 26 such that the ribs traverse the longitudinal axis of the tissuepad 28, as shown in FIG. 2 (dashed lines representing an exemplar rib 26traversing the tissue pad). The bladder 16 is then placed atop thechassis 32 and filled (in whole or in part) with fluid from syringe 40.The rib portion 12 is then closed and the clamp 20 reassembled andsecured with pins 30 as shown in FIG. 3. Next, the anatomical model ismounted to a human, preferably a live patient actor, reclined on asurgical bed.

Having provided the device, chest tube insertion using the device maynow be performed. For this example, the outer surface of the rib portion(corresponding to a human chest) may be prepped with an antisepticsimulant and surrounded with sterile towels and/or drapes. Next, thetrainee palpates the rib portion 12 and injects an anesthetic simulantby inserting a needle superficially into the tissue pad 28. The traineepalpates rib again and this time utilizes a larger bore needle above therib to enter the pleural space through an intercostal space (for examplethe region in the model corresponding to the fourth intercostals space).As the bore needle enters the pleural space, the trainee aspirates untilhe or she makes contact with the “hemothorax” (simulated by the fluidcontained within the bladder). The trainee removes the plunger portionof the needle leaving the needle open to air to decompress any pressurebuilt up in pleural space.

Next the chest tube is inserted. The trainee prepares for chest tubeplacement by incising the ouster surface of the rib portion 12 and usinga finger for blunt dissection down to pleural lining. The intercostalmuscles simulated by the tissue pad 28 must then be opened by, forexample, a Kelly clamp to gain access to pleural layer. This causes anegress of “blood” (fluid from the inside the bladder 16) as the traineeinserts the Kelly clamp into the simulated pleural space. The traineethen inserts a chest tube through the opening created by the Kellyclamp. The chest tube is attached to a standard pleuro-vacuum to helpevacuate the hemothorax and is lastly sutured and dressed.

The training exercises and methods performed using the provided devicemay vary. For instance, a three way stopcock could be placed on theneedle and used for intermittent “venting” of pleural space duringtransport. Also, as methods change and improve for performingthoracostomy, these procedures may also be performed on the provideddevice. Also, the bladder could be partially filled or left empty so asto simulate a pneumothorax and/or pneumohemothorax.

All cited references including publications and patent documents citedin this specification are herein incorporated by reference in theirentireties as if each individual publication or patent application werespecifically and individually indicated to be incorporated by reference.Although the foregoing methods and compositions have been described insome detail by way of illustration and example for purposes of clarityof understanding, it will be readily apparent to those of ordinary skillin the art in light of the teachings of these methods that certainchanges and modifications may be made thereto without departing from thespirit or scope of the disclosure. The present invention is not to belimited in scope by the specific embodiments disclosed in the examples,which are intended as illustrations of a few aspects of the invention,and any embodiments that are functionally equivalent are within thescope of this invention. Indeed, various modifications of the inventionin addition to those shown and described herein will become apparent tothose skilled in the art and are intended to fall within the scope ofthe disclosure.

What is claimed is:
 1. A device comprising an anatomical model forsimulating at least a portion of a thorax, the anatomical modelcomprising a rib portion removably secured to and supported by a base,the rib portion comprised in whole or in part of a hydrogel; a securingmember for holding the anatomical model onto a human; wherein the ribportion has a convex shape defining a space between the base and the ribportion, the space is adapted for receiving a bladder disposed betweenthe rib portion and the base; wherein at least a portion of the base isformed from puncture resistant material; wherein the base comprises achassis made in whole or in part of armor grade material; and whereinthe chassis has thereon a binding for pivotally receiving at least aportion of a distal end of the rib portion, and a clamp for removablyengaging at least a portion of a proximal end of the rib portion.
 2. Thedevice as in claim 1, further comprising a chest tube training device.3. The device of claim 1, wherein the rib portion further comprises atissue pad removably engaged with and surrounding at least a portion ofa plurality of ribs.
 4. The device of claim 3, wherein the tissue pad iscomprised in whole or in part of a hydrogel; said tissue padgeometrically mimics at least a portion of human or nonhuman animal ribtissue; and said tissue pad is configured to simulate at least onepredetermined physical characteristic of human or non human animal ribtissue with at least 50% or more similarity.
 5. The device of claim 4wherein the at least one predetermined characteristic of the rib tissuecomprises at least one of the following: color, tensile modulus, shearstrength, puncture resistance, compressive modulus, dielectric constant,electrical conductivity, and/or thermal conductivity.
 6. The device ofclaim 1, wherein the ribs geometrically mimic at least a portion or aplurality of human or non human animal rib bones and are said ribs areconfigured to simulate at least one predetermined physicalcharacteristic of human or non human animal living bone.
 7. The deviceof claim 6 wherein the at least one predetermined characteristic of theliving bone comprises at least one of the following: hardness, color,tensile modulus, shear strength, puncture resistance, compressivemodulus, dielectric constant, electrical conductivity, and/or thermalconductivity.
 8. The device of claim 1, wherein the bladder is a hollowpouch for simulating at least a pleura, pleural space or both.
 9. Thedevice of claim 1, wherein the bladder is comprised in whole or in partof a hydrogel or silicone, or both; said bladder geometrically mimics atleast a portion of human or nonhuman animal pleura, pleural space, orboth; and said bladder is configured to simulate at least onepredetermined physical characteristic of a human or non human animalpleura, pleural space, or both with at least 50% or more similarity. 10.The device of claim 9 wherein the at least one predeterminedcharacteristic of the pleura, pleural space, or both comprises at leastone of the following: color, tensile modulus, shear strength, punctureresistance, compressive modulus, dielectric constant, electricalconductivity, and/or thermal conductivity.
 11. The device of claim 8,wherein the bladder is further configured to receive one or more fluids,air, or both.
 12. The device as in claim 11, wherein the bladder isfilled with contents comprising the one or more fluids, air, or both,wherein the contents simulate a predetermined characteristic of one of agroup consisting of: a hemothorax, pneumothorax, and pneumohemothorax.13. The device of claim 1, wherein the human is a live patient actor 14.The device of claim 1, wherein the human is a mannequin.